Medical billing services in Louisiana

Louisiana Medicaid (Healthy Louisiana) is run by the Louisiana Department of Health (LDH), Bureau of Health Services Financing. Fee-for-service claims and provider enrollment go through the lamedicaid.com provider portal (Gainwell Technologies)¹, at www.lamedicaid.com. About 84 percent of Louisiana Medicaid enrollees (1,403,545 of 1,676,215 in 2024) were in a full-benefit Healthy Louisiana managed care organization; the same six plans also carry the behavioral health benefit, dental runs through two prepaid dental plans, and the Coordinated System of Care for children runs through Magellan⁶. CMS managed care enrollment data for 2024; the plan list below comes from the same CMS report. Members in nursing facilities, adults in ICF/IIDs and the other excluded populations keep legacy fee-for-service Medicaid.

Fee-for-service filing limit: 12 months from the date of service for Medicaid-only claims and for claims with a third-party payment; a Medicare crossover that fails to cross electronically must reach Medicaid no later than six months after the Medicare EOMB date, provided Medicare got it inside a year of the service². Proof of timely filing is a remittance advice or an e-CSI screen print showing the claim processed in time, or correspondence from the state or parish eligibility office about the claim or the beneficiary; ERA screen printouts, rejection letters and certified mail receipts are not accepted. A claim more than two years old is considered only for retroactive certification, a Medicare or Social Security appeal that granted retroactive benefits, or a state error. Healthy Louisiana plans set their own windows in their manuals; UnitedHealthcare's is 365 days from the date of service, and 365 days from the primary EOB for coordination of benefits.

Managed care plans⁷

• Louisiana Healthcare Connections400,299 members in 2024
• UnitedHealthcare Community Plan343,798 members in 2024
• Healthy Blue253,620 members in 2024
• AmeriHealth Caritas Louisiana153,970 members in 2024
• Aetna Better Health of Louisiana131,535 members in 2024
• Humana Healthy Horizons119,887 members in 2024
• DentaQuestDental benefit plan (prepaid ambulatory health plan)
• MCNA of LouisianaDental benefit plan (prepaid ambulatory health plan)

Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Louisiana Medicaid through one plan is not in network with the others until each contract is in place.

Commercial payers active in Louisiana¹¹: Blue Cross and Blue Shield of Louisiana, HMO Louisiana, UnitedHealthcare, Ambetter from Louisiana Healthcare Connections, CHRISTUS Health Plan, AmeriHealth Caritas Next. Filing windows, corrected-claim processes and appeal levels differ from one to the next, and each payer sets them out in its own provider manual; the timely filing limits table gathers verified payer deadlines with their sources.

For Medicaid managed care, the clean-claim payment standard under the Healthy Louisiana MCO contract: 90 percent of clean claims paid within 15 business days of receipt and 100 percent within 30 calendar days, with interest at 12 percent per annum on a clean claim left unadjudicated past 30 days⁸. UnitedHealthcare Community Plan's 2026 Louisiana manual states the standard its LDH contract sets: interest is calculated daily for the full period past the 30-day deadline and paid on the same date as the claim, pended claims are paid or denied within 60 calendar days of receipt, and the plan runs at least one provider payment cycle a week on the same day. Commercial insurers answer to the state insurance code instead, and each carrier's own manual states its clean claim deadline. In A/R follow-up, a managed care claim that is past that standard is raised with the plan, with the contract term cited.